A response to “screen based lifestyle harms children’s health”

On Christmas Day this year, multiple clinicians and academics wrote to The Guardian newspaper to express their concern about the impact of ‘screentime’ on children’s health. In this post, we will extract key phrases from the letter, which can be seen in its entirety here, and explore whether the evidence upholds the statement. In this, I am joined by my husband, Ben Fletcher-Watson. While my research has mainly focused on the role of technology in the lives of children on the autism spectrum, Ben has been involved in a number of research projects (some cited below) investigating the use of technologies in the home by typical pre-schoolers, and especially the ways in which parents engage in technology use with their children.

We will focus on the role of screentime specifically, which is one of the modern phenomena that is blamed for what the letter-writers call “toxic childhood“. However, we should note that the writers also cite “a hyper-competitive schooling system and the unremitting commercialisation of childhood” as negative influences – we do not address these here.

This sentence wraps up the entire position of the letter in a nutshell. The hypothesis proposed is that: a) screentime has increased; b) it has displaced outdoor play specifically; and c) this has had an impact on health and well-being. There are no studies which can directly address all of these posited links in one go. The closest is a paper by Parkes et al. which should really be the last word on the relation between screentime and developmental outcomes thanks to its sample size of 11,000 children and robust longitudinal design. This explored thirty potential statistical relations and found just one small link between TV-watching at five-years-old and conduct problems at seven-years-old.

Sue analysed the results of this paper in more detail in a previous blog post, but there’s a key point which needs to be extracted here. The only significant relation that was found was between TV-watching (i.e. passive viewing) and outcome. The authors did also measure the effect of video gaming and found that this had no discernible impact on outcomes two years later. This is important in relation to the letter-writers’ claim, because there is no evidence that TV-watching has increased. In fact, this 2006 systematic review reports that time spent watching TV did not increase over the preceding 50 years.

Instead, recent increases in screentime have been driven by increased access to touchscreen devices, which invite active viewing and play (unlike TV). Not only did Parkes and colleagues find no link from active game play to outcomes, but this has since been reinforced and extended in a rare example of a good quality study on the topic. The authors – including the late and very great Annette Karmiloff-Smith – report no link between touchscreen use and early developmental milestones in toddlers.

What about reductions in outdoor play? Is screentime really displacing this activity and making kids fat? Once more, the evidence says not, as in this large, national survey which found no links between TV-watching, outdoor play and body-mass index in children aged three-years-old. A more recent, longitudinal study with 19,000 pre-schoolers enrolled reinforced the message that watching more TV and less physical activity are related only via a shared factor – perceived neighbourhood safety. In other words, when parents think their neighbourhood is unsafe, children get out less and watch more TV. Crucially, even these associations are weaker over time, and neither physical activity nor TV watching is actually predictive of body-mass index.

Thus the plausibility of the argument hinges on a series of correlations which do not stand up to scrutiny. Screentime probably has increased thanks to the proliferation of touchscreen devices. But TV watching (which is the only form of screentime which has been linked to poor outcome) has not increased. There’s no evidence that screentime is replacing play outdoors, and no evidence that either of these things can explain the so-called “obesity crisis”. Instead, quality evidence which controls for important confounders like socio-economic factors reveals that screentime is not linked to poor outcomes or delayed development.

Physical health problems like obesity continue to escalate, and mental health problems among children and young people are approaching crisis levels.

What about mental health? We’re afraid that here the Guardian letter-writers are succumbing to a basic correlation = causation error. The writers might like to check out these spurious correlations as a reminder of this basic scientific principle. It is true that childhood disability rates are rising, with particular increases in the prevalence of diagnosed mental health and neurodevelopmental conditions in Western countries since the turn of the century. The authors point out that changing diagnostic criteria and increased awareness of childhood mental health conditions are likely to be major factors contributing to these shifts. However, a specific meta-analysis focused only on child and adolescent mental health reveals that, on the whole, the severity of these conditions has not changed in the 21st century. Importantly, there is absolutely no evidence linking any change in rates of diagnosis of mental health conditions with any technology-related factors.

If children are to develop the self-regulation and emotional resilience required to thrive in modern technological culture, they need unhurried engagement with caring adults and plenty of self-directed outdoor play, especially during their early years (0–7).

… [the writers call for]… National guidelines on screen-based technology for children up to the age of 12, produced by recognised authorities in child health and development.

This call is utter nonsense unless the monolithic notion of ‘screen-based technology’ is broken down in meaningful ways. One of the biggest problems we have with efforts to demonise screentime is the ignorance of those who undertake to do so. History is crowded with examples of people writing new inventions off as worthless, or damaging, due to ignorance of their potential. See one example below – Socrates’ opinion of the new technology of “writing”, as given by Plato:

I’ve said it before and I’ll say it again, THERE’S NO SUCH THING AS SCREENTIME. Right now, we are writing this blog post on Sue’s laptop. Earlier today, Ben Skyped his parents with the children, while Sue looked up the weather on a smartphone app before using the same phone to load up a family bus ticket and take the kids to the beach. At the beach, we filmed them jumping over waves in their wellies and we looked back at the footage in a cafe. Sue then browsed Twitter while the kids played in the playground, before we all came home and they settled down to play the new Lego Elves iPad app in conjunction with the new Lego toys they’ve been building since Christmas. Later, we’ll watch the final episode of Planet Earth 2 together as a family. To bracket all of those activities as ‘screentime’ is clearly nonsense. Any research on this issue needs to capture the quality, not just the quantity, of activities engaged in by children and attempt to make distinctions between more or less valuable types of engagement.

Without concerted action, our children’s physical and mental health will continue to deteriorate, with long-term results for UK society that are frankly unthinkable.

Rubbish.

In particular, this kind of call utterly ignores the huge benefits that the internet, online gaming, social media networks, active games, tangibles and robotics can deliver. In particular, the ways in which these technologies can level the playing field for people in remote communities, from disadvantaged backgrounds or those with disabilities is utterly ignored by these authors.

And yet, despite what you may think from this post and others, we are not uncritically in favour of technology use by children. We agree that it is important to collect evidence on the potential benefits and disadvantages of different kinds of technology use at different stages of development. In particular, parents should be aware of the potential difference between passive viewing and active engagement and should help their children balance these different kinds of ‘screentime’. Children need to be encouraged to develop self-control in the technological world, as they do in all things (i.e. when it is time to leave the playground, when they’ve eaten the last sweet). Good digital etiquette for orchestrating social relationships online, and knowledge about digital security are also important as children grow up and gain independence (online and off). This page has a useful round-up of digital skills which children should learn (and which parents and educators should be able to impart).

So, if you were writing a letter to The Guardian, what would you call for?

We call for children to be given the resources and the tools to explore and benefit from the digital world as their parents do.

We call for research to capture the nuance and detail of engagement with technology and understand HOW rather than HOW MUCH new technologies should be used.

We call for technology developers in the commercial sector to work with academics, educators and families to create digital worlds where children can play and learn in a way which meets their needs and expands their experiences.

We call for anyone making pronouncements on child development to support their arguments with quality evidence.

We call for parents not to switch off, but instead to switch on to technology, and engage with their child’s digital learning and play.